| NPI | 1861675159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENGYU LAI Chief Manager 507-218-3095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2011-05-12 |